Hemodialysis is a method of cleansing blood using an artificial kidney (dialysis) machine. A vascular access is a way to reach blood for the dialysis procedure.
For proper cleansing, blood has to travel through the dialysis machine at high flow. This is best achieved by using an arterio-venous (AV) fistula. An AV fistula
is a vascular access made by joining an artery and vein. The high pressure of the arterial blood flow causes the vein to enlarge and thicken (a process known as maturation).
Once an AV fistula is mature, two needles are placed in the fistula to draw and return blood. The process is similar to putting two iv's in a vein, and therefore it can be
performed by a nurse at a dialysis center. Creation of an AV fistula requires a specialized operation that is usually performed by a vascular surgeon.

The specialists at the Miami Renal institute work with Marwan Tabbara, M.D., an experienced vascular surgeon at the Division of Vascular Surgery at the University of Miami Miller School of Medicine.
Dr. Tabbara is an associate professor of surgery and in charge of the Vascular Access Program and the Non-Invasive Vascular Laboratory at the University of Miami Hospital.
Dr. Tabbara has published extensively on dialysis vascular access and has given lectures at medical centers across the United States.

Allan BJ, Perez ER, Tabbara M. Analysis of 855 upper extremity fistulas created using a standard protocol: the role of graft extension to achieve functional status.
The American Surgeon. 2013 Jun;79(6):625-9